Annals of Surgical Oncology

, Volume 20, Issue 12, pp 3754–3760 | Cite as

Resection of Hepatocellular Carcinoma with Macroscopic Vascular Invasion

  • Sasan Roayaie
  • Ghalib Jibara
  • Bachir Taouli
  • Myron Schwartz
Hepatobiliary Tumors



Survival for Child’s A patients with hepatocellular cancer (HCC) and macroscopic vascular invasion (MVI) has been reported as approximately 8.1 months with sorafenib. The role of surgery for these patients remains controversial.


The records of all patients undergoing resection of HCC at a single center were reviewed. Only patients with pathologically proven MVI were included. Inclusion criteria for resection required Child’s A liver disease, no clinical portal hypertension (after 2002), and no extrahepatic disease. The superior mesenteric vein and portal vein branch to the remaining lobe had to be patent.


We identified 165 patients with MVI treated with hepatic resection between June 1992 and March 2010. Median follow-up was 11.9 months with 127 deaths, including 12 (7.3 %) perioperative mortalities. Median and 5-year survivals were 13.1 months and 14 %. Multivariate analysis found α-fetoprotein (AFP) >30 ng/ml (hazard ratio 2.07), tumor size >7 cm (hazard ratio 1.59), and extent of vascular invasion (hazard ratio 1.74) to be independently associated with survival. Those with invasion of hepatic veins or vena cava had a median survival of only 4.7 months.


The results for resection of HCC with MVI remain somewhat disappointing but are better than what is reported with medical therapy in similar patients. Tumor size, AFP, and extent of vascular invasion can help select those that will benefit most from hepatic resection. Resection of patients with hepatic vein or vena cava involvement may not be justified, given such poor results.


Sorafenib Tace Hepatic Vein Hepatic Resection Main Portal Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sasan Roayaie
    • 1
  • Ghalib Jibara
    • 1
  • Bachir Taouli
    • 2
  • Myron Schwartz
    • 1
  1. 1.Mount Sinai Liver Cancer ProgramMount Sinai Medical CenterNew YorkUSA
  2. 2.Department of RadiologyMount Sinai Medical CenterNew YorkUSA

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